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Bo A, Jaccard J. Perceived Racial and Ethnic Discrimination, Depression, and Alcohol Use Intentions Among Inner-City Latinx Youth: Cross-Generational Effects. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024:10.1007/s11121-024-01695-6. [PMID: 38862830 DOI: 10.1007/s11121-024-01695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
Among the many social determinants linked to adolescent alcohol use and depression, racial and ethnic discrimination is a prevalent determinant among Latinx adolescents and adults that is largely overlooked in preventive interventions. This study explored the influence of perceived racial and ethnic discrimination on depressive symptoms and alcohol use intentions among Latinx adolescents. Additionally, the study explored the cross-generational effects of how mothers' perceived discrimination impacts the depressive symptoms and alcohol use of the adolescent. The study used a sample of 800 inner-city Dominican and Puerto Rican adolescent-mother dyads (adolescent mean age = 12.42 years, SD = 0.81; mother mean age = 40.55 years, SD = 8.70). Employing a five-wave panel design that followed adolescents from 8th grade to 10th grade, the study found statistically significant mediation pathways which showed that adolescents' self-reported racial and ethnic discrimination experiences were associated with increases in their immediate and long-term depressive symptoms, which in turn were associated with stronger intentions to use alcohol in the future. Further, perceived racial and ethnic discrimination experienced by Latinx mothers was associated with increases in adolescents' intentions to drink alcohol in the future, mediated by the mothers' depressive symptoms and subsequently the adolescents' depressive symptoms. As discussed, these findings have wide-ranging implications for alcohol use prevention programs targeting inner-city Latinx adolescents.
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Affiliation(s)
- Ai Bo
- Helen Bader School of Social Welfare, Department of Social Work, University of Wisconsin-Milwaukee, Enderis Hall 1175, 2400 E. Hartford Ave, Milwaukee, WI 53211, USA.
| | - James Jaccard
- Silver School of Social Work, New York University, New York, USA
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Li Y, Maina G, Mousavian G, Fang Y, Twum-Antwi B, Sherstobitoff J, Amoyaw J, Pandey M. Family-based Interventions of Preventing Substance Use Among Immigrant Youth: A Scoping Review. SUBSTANCE USE : RESEARCH AND TREATMENT 2024; 18:29768357241244680. [PMID: 38707894 PMCID: PMC11069246 DOI: 10.1177/29768357241244680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/15/2024] [Indexed: 05/07/2024]
Abstract
Introduction Immigrant youth face heightened risks of substance use due to the stress associated with immigration and acculturation. While parental intervention can have a preventative impact on substance use, parents need to be well-informed about substance use and effective interventions that can prevent substance use among immigrant youth. Such interventions ought to be culturally sensitive, family-based, and targeted at the specific substances that are prevalent in a given context. Identifying and curating interventions that can empower parents in addressing substance use can help mitigate the risks that immigrant youth may face. Methods This scoping review aimed to identify the types, characteristics, and effectiveness of family-based substance use intervention programs. Based on Arksay and O'Malley's guidelines, interventions included in the review must have met the following criteria: (a) was a family-based intervention aiming to prevent substance use; (b) targeted immigrant teens aged 12 to 17 years old; (c) was published in English; (d) originated from Australia, Canada, New Zealand, or the United States. The pinch table was used to synthesize included articles, after which studies were compared and categorized, and cross-cutting categories were identified. Results After screening 4551 searched literature, 13 studies that utilized family-based interventions were included in the review. All interventions were face-to-face programs, and most interventions involved parents and youth as participants. Eco-developmental theory and active learning strategies were used by multiple interventions. Given immigrant families were target stakeholders, both deep structure and surface structure cultural adaptations were utilized. Interventions increased parents' knowledge and skills regarding substance use prevention and delayed substance use initiation among youth. Conclusion From the review, it was evident that parents are an essential element in any program aiming to prevent or reduce children's substance use. Besides information about substance use prevention, the curriculum also involves parenting and communication skills for parents to understand the protective effects of family. Effective family-based interventions for immigrant youth require attention to parenting and immigration stress, while also considering cultural adaptation. Future directions and limitations are also discussed.
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Affiliation(s)
- Yiyan Li
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Geoffrey Maina
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Ghazal Mousavian
- College of Graduate and Postdoctoral Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yiting Fang
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Barbara Twum-Antwi
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | | | - Jonathan Amoyaw
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
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Vega-López S, Ayers S, Gonzalvez A, Campos AP, Marsiglia FF, Bruening M, Rankin L, Vega Luna B, Biggs E, Perilla A. Diet Outcomes from a Randomized Controlled Trial Assessing a Parenting Intervention Simultaneously Targeting Healthy Eating and Substance Use Prevention among Hispanic Middle-School Adolescents. Nutrients 2023; 15:3790. [PMID: 37686822 PMCID: PMC10489966 DOI: 10.3390/nu15173790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Parents play a significant role in adolescent health behaviors; however, few nutrition interventions for Hispanic adolescents involve parents. This study assessed the effects of a 10-week parenting intervention simultaneously targeting nutrition and substance use prevention. Hispanic parent/6th-8th-grade adolescent dyads (n = 239) were randomized to Families Preparing the New Generation Plus (FPNG+; nutrition/substance use prevention), FPNG (substance use prevention only), or Realizing the American Dream (RAD; academic success control). Surveys assessed diet, alcohol use, substance use intentions, and substance use norms at baseline (T1), immediately post-intervention (T2), and at 16 weeks post-intervention (T3). Latent change modeling assessed diet changes; adolescent substance use outcomes were assessed using effect sizes. Among adolescents, those in FPNG+ increased fruit (+0.32 cup equivalents, p = 0.022) and fiber intake (+1.06 g, p = 0.048) and did not change added sugars intake at T2; those in FPNG and RAD reduced their intake of fruit and fiber (p < 0.05 for both). FPNG+ parents marginally increased fruit/vegetable intake (+0.17 cup equivalents, p = 0.054) and increased whole grains intake (+0.25-ounce equivalents, p < 0.05), in contrast to the reduction among RAD and FPNG parents (p < 0.05). Reductions in added sugar intake at T2 were greater among FPNG and FPNG+ parents relative to RAD parents (p < 0.05). FPNG+ and FPNG had comparable substance use outcomes (i.e., both had lower alcohol use and intentions to use substances relative to RAD). Engaging parents in a nutrition and substance use prevention parenting intervention yielded positive changes in dietary intake and maintained substance use prevention outcomes among their adolescent children.
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Affiliation(s)
- Sonia Vega-López
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Anaid Gonzalvez
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Ana Paola Campos
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
- Global Center for Applied Health Research, Arizona State University, Phoenix, AZ 85004, USA;
| | - Flavio F. Marsiglia
- Global Center for Applied Health Research, Arizona State University, Phoenix, AZ 85004, USA;
| | - Meg Bruening
- Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University, University Park, PA 16802, USA;
| | - Lela Rankin
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Beatriz Vega Luna
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Elizabeth Biggs
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix, AZ 85004, USA; (S.A.); (A.G.); (A.P.C.); (L.R.); (B.V.L.); (E.B.)
| | - Alex Perilla
- WeGrad (Formerly American Dream Academy), Arizona State University, Phoenix, AZ 85004, USA;
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Champion KE, Gardner LA, McCann K, Hunter E, Parmenter B, Aitken T, Chapman C, Spring B, Thornton L, Slade T, Teesson M, Newton NC. Parent-based interventions to improve multiple lifestyle risk behaviors among adolescents: A systematic review and meta-analysis. Prev Med 2022; 164:107247. [PMID: 36075490 DOI: 10.1016/j.ypmed.2022.107247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/11/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
Lifestyle risk behaviors often co-occur and are prevalent among adolescents. Parent-based interventions addressing risk behaviors concurrently have the potential to improve youth and parent outcomes. This systematic review evaluated the efficacy of parent-based interventions targeting multiple lifestyle risk behaviors among adolescents and parents. MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Scopus, CINAHL, the Cochrane Database of Systematic Reviews (CDSR) and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 2010-May 2021. Eligible studies were randomised controlled trials (RCTs) of parent-based interventions addressing 2+ risk behaviors: alcohol use, smoking, poor diet, physical inactivity, sedentary behaviors, and poor sleep. Studies directly targeting parents, and that assessed adolescent outcomes (11-18 years) were eligible. Where possible, random-effects meta-analysis was conducted. From 11,975 identified records, 46 publications of 36 RCTs (n = 28,322 youth, n = 7385 parents) were eligible. Parent-based interventions were associated with improved adolescent moderate-to-vigorous physical activity (MVPA) [Odds Ratio (OR) = 1.82, 95% CI = 1.18, 2.81; p = 0.007], and reduced screen time (SMD = -0.39, 95% CI = -0.62, -0.16, p = 0.0009) and discretionary food intake (SMD = -0.18; 95% CI = -0.30, -0.06; p = 0.002) compared to controls. However, there was some evidence that interventions increased the odds of ever using tobacco in the medium-term (OR = 1.47, 95% CI = 0.99, 2.18, p = 0.06) and of past month tobacco use in the long-term (OR = 1.46, 95% CI = 1.12, 1.90; p = 0.005). Overall, the quality of evidence was moderate. Parent-based interventions targeting multiple risk behaviors improved adolescent MVPA, and reduced screen time discretionary food intake. Further research is needed to address sleep problems and increase intervention efficacy, particularly for alcohol and tobacco use.
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Affiliation(s)
- Katrina E Champion
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia.
| | - Lauren A Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Karrah McCann
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Emily Hunter
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Belinda Parmenter
- School of Health Sciences, Faculty of Medicine and Health, Wallace Wurth Building (C27), Cnr High St & Botany St, UNSW Sydney, Sydney, Australia
| | - Tess Aitken
- University of Sydney Library, University of Sydney, Sydney 2006, NSW, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Dr, Suite 1400, Chicago, IL 60611, United States
| | - Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia; School of Medicine and Public Health, The University of Newcastle, University Dr, Callahan NSW, 2308 Newcastle, Australia; School of Public Health and Community Medicine UNSW, UNSW Sydney, NSW 2052, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Level 6, Jane Foss Russell Building GO2, University of Sydney, Camperdown, 2006 Sydney, Australia
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Valadez-García JA, Oropeza-Tena R, Vasquez G. Evaluación de una intervención preventiva del consumo de drogas al agregar un componente para padres. REVISTA DE ESTUDIOS E INVESTIGACIÓN EN PSICOLOGÍA Y EDUCACIÓN 2021. [DOI: 10.17979/reipe.2021.8.2.8458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
El objetivo de este estudio fue evaluar la eficacia de la Intervención Preventiva para Estudiantes Adolescentes en Riesgo (IPEA-R) cuando se combina con la Intervención Mínima para Padres de Adolescentes en Riesgo (IMPA-R). El estudio tuvo un diseño cuasi-experimental. La muestra estuvo formada por 25 estudiantes de secundaria, 10 mujeres y 15 varones (edad promedio 12.10 años, DE = 0.32), y se dividió en dos grupos: el grupo IPEA-R (n = 15) y el grupo IPEA-R+IMPA-R (n = 10). A ambos grupos se les aplicó la IPEA-R, que consta de una sesión se evaluación, ocho de intervención y dos de seguimiento. El segundo grupo recibió además la IMPA-R dirigida a sus padres, que consiste en cuatro sesiones de intervención y dos de seguimiento. Los instrumentos utilizados para el estudio fueron: la Escala de Detección de Consumo de Alcohol, Tabaco y Marihuana, la Escala de Resistencia a la Presión de Amigos, la Escala para la Evaluación del Manejo de Emociones, el Cuestionario de Percepción de Riesgos del Consumo de Drogas, y la Escala de Ambiente Familiar. Se llevó a cabo un ANOVA mixto para identificar diferencias entre los dos grupos en las mediciones pre-test, post-test, primer seguimiento y segundo seguimiento. Se encontraron diferencias estadísticamente significativas en relación con: claridad emocional, reparación emocional, comunicación del hijo, apoyo del hijo, comunicación de los padres, y hostilidad y rechazo. La intervención IPEA-R+IMPA-R mostró efectos positivos en el manejo de emociones y la percepción del ambiente familiar en los adolescentes.
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Cutrín O, Kulis SS, Ayers SL, Jager J, Marsiglia FF. Perception of Parental Knowledge by Parents and Adolescents: Unique Effects on Recent Substance Use in a Latinx Sample. JOURNAL OF LATINX PSYCHOLOGY 2021; 9:189-203. [PMID: 34738080 PMCID: PMC8562724 DOI: 10.1037/lat0000155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The main objective of the current study is to analyze how the unique perspectives from both parents and children in regards to parental knowledge of the child's whereabouts, activities, and friendships are related to the adolescent's recent substance use four months later. Differences between parents and children, as well as between male and female adolescents are examined. Data come from a Latinx sample (mostly Mexican-origin) of 523 parent-adolescent dyads from Arizona (US) using a multi-informant approach (parent and adolescent reports). The results indicate that parents, especially mothers, report higher levels of parental knowledge than adolescents do. The structural equation modeling (SEM) results for the total sample indicate that both parents' and adolescents' unique perception of the level of parental knowledge is negatively related to the adolescents' recent alcohol and cannabis use four months later. Further, multi-group SEM results split by gender indicate that parents' unique perception of higher levels of parental knowledge is only marginally related to lower alcohol use for both males and females, whereas adolescents' unique perception is negatively related to alcohol and cannabis use (significantly) and tobacco use (marginally) for both males and females. No significant gender differences were found in the effects of parental knowledge on substance use. Findings suggest that parents' and adolescents' perceptions seem to be quite distinctive and independent from each other. Implications of these results regarding intervention programs for preventing substance use are discussed.
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López-Tamayo R, Jason LA. THE ASSOCIATION BETWEEN BEHAVIORAL AND ATTITUDINAL ACCULTURATION ON LATINX IMMIGRANTS AND U.S.-BORN LATINXS: A MULTIDIMENSIONAL ACCULTURATION MODEL. COMMUNITY PSYCHOLOGY IN GLOBAL PERSPECTIVE 2021; 7:81-102. [PMID: 36457550 PMCID: PMC9710741 DOI: 10.1285/i24212113v7i2p81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Disparities in access and utilization of substance abuse treatment (SAT) among Latinxs, accentuated by this population's rapid growth, create a public health issue. Although substance abuse literature has given more consideration to environmental factors and social support concerning treatment outcomes, current substance abuse models fail to address important contextual and cultural aspects for Latinxs in recovery, including acculturation. The proposed study aims to test out a multidimensional acculturation model on a sample of 131 Latinxs (Mage= 36.3; SD±10.4, 117 males, 49% immigrants) who recently completed SAT. Specifically, the proposed study employed a conditional process model using the PROCESS Macro for SPSS to examine the association between behavioral acculturation and substance use behavior in the past six months on nativity status at different levels of attitudinal acculturation. Results yielded that, after controlling for age and substance use, higher endorsement of U.S. mainstream cultural practices was associated with a higher frequency of days using alcohol among Latinx immigrants, specifically those reporting high and very high affiliation to the U.S. mainstream culture. Also, a negative association between U.S. mainland-born Latinx and frequency of days using illicit drugs in the past six months was observed, but only among those who endorse very high affiliation of U.S. mainstream culture.
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Affiliation(s)
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, USA
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An examination of classes of school climate perceptions among Latinx middle school students. J Sch Psychol 2020; 82:70-84. [PMID: 32988464 DOI: 10.1016/j.jsp.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 05/22/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022]
Abstract
Several studies have replicated the finding that Latinx students tend to have less favorable perceptions of school climate than their White peers. However, because most research compares Latinx students to a White standard, little is known about variation within the Latinx group and thus the opportunity to produce strength-defining counter-narratives has been missed. Using latent class analysis, this study identified meaningful classes of school climate perceptions within 20,050 Grade 7 Latinx students in California. Five climate classes were identified, lending support to the hypothesis that substantial heterogeneity of school climate perceptions exists within the Latinx student population. The results support the utility of latent class modeling for examining school climate perceptions beyond traditional variable-centered approaches. Countering the prevailing deficit narrative, the results indicate that nearly half of all Latinx respondents reported generally positive perceptions of school climate. Conversely, supporting the need for environmental supports that encourage Latinx students to voice their concerns and make decisions regarding systems that affect them, over three-quarters of the responses suggested that Latinx students perceive meaningful participation at school negatively. The results suggest the possibility of a cascade effect in the development of the psychological experience of the school, such that some dimensions of school climate perceptions may be antecedents to others. Implications for further research and intervention are discussed.
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Villegas-Pantoja MÁ, Méndez-Ruiz MD, Valle-Alonso MDJD, García-Perales LA. Nursing Course on Drug Addiction and its Effects on Beliefs and Intentions: A Quasi-experimental Study. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine the impact of a course aimed at the care of persons with drug dependence on the beliefs and intentions of drug use among bachelor nursing students.
Materials and methods: A quasi-experimental study conducted with a non-equivalent comparison group composed of 210 Mexican students of both sexes. Two Likert-type instruments were used to measure the beliefs and intentions of drug use, before and after a semester-long course.
Results: At the end of the study, a significant interaction was found (F = 3.56, p = 0.050, η2p = 0.025), which suggests a greater decrease in beliefs in favor of drug use among students who took the course on drug addiction. Regarding drug use intentions, a general decrease was observed in the entire sample (F = 10.13, p = 0.002, η2p = 0.059).
Conclusions: Courses on the care of drug addiction can have beneficial effects on nursing students by modifying beliefs and intentions to carry out unhealthy behaviors such as the use of substances. These results demand to verify if the effects remain beyond the completion of university education.
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Preparing Teens to Stay Safe and Healthy on the Job: a Multilevel Evaluation of the Talking Safety Curriculum for Middle Schools and High Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:510-520. [PMID: 30904978 DOI: 10.1007/s11121-019-01008-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
US adolescents experience a higher rate of largely preventable job-related injuries compared with adults. Safety education is considered critical to the prevention of these incidents. This study evaluates the effectiveness of a foundational curriculum from the National Institute for Occupational Safety and Health (NIOSH), Talking Safety, to change adolescents' workplace safety and health knowledge, attitude, subjective norm, self-efficacy, and behavioral intention to engage in workplace safety actions. The study also examines the impact of teacher fidelity of curriculum implementation on student outcomes. A multilevel evaluation, based on a modified theory of planned behavior, was conducted in 2016 with 1748 eighth-graders in Miami-Dade, Florida. Post-intervention, students had statistically significant increases (p < .05) in mean scores across outcomes: workplace safety knowledge (34%), attitude (5%), subjective norm (7%), self-efficacy (7%), and behavioral intention (7%). Consistent with theory, gains in attitude (b = 0.25, p < .001), subjective norm (b = 0.07, p < .01), and self-efficacy (b = 0.55, p < .001) were associated with gains in behavioral intention. Higher levels of implementation fidelity were associated with significant gains across outcome measures: knowledge (b = 0.60, p < .001), attitude (b = 0.08, p < .01), subjective norm (b = 0.04, p < .001), self-efficacy (b = 0.07, p < .01) and behavioral intention (b = 0.07, p < .01). Findings demonstrate the effectiveness of Talking Safety, delivered with fidelity, at positively changing measured outcomes, and provide support for using this curriculum as an essential component of any school-based, injury prevention program for young workers.
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Vega-López S, Marsiglia FF, Ayers S, Williams LR, Bruening M, Gonzalvez A, Vega-Luna B, Perilla A, Harthun M, Shaibi GQ, Delgado F, Rosario C, Hartmann L. Methods and rationale to assess the efficacy of a parenting intervention targeting diet improvement and substance use prevention among Latinx adolescents. Contemp Clin Trials 2020; 89:105914. [PMID: 31843638 PMCID: PMC7242150 DOI: 10.1016/j.cct.2019.105914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/27/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
Latinx adolescents are at higher risk for chronic diseases relative to adolescents of other ethnic groups, in part because of their lack of adherence to diet recommendations and their higher rates of substance use. Given the proximal influence of family factors during the developmental stage of adolescence, parenting interventions may be an effective way to promote healthy nutrition and substance use prevention simultaneously. This article describes the design and theoretical rationale of a study assessing the effects of Families Preparing the New Generation Plus (FPNG Plus), a 10-week culturally-tailored nutrition and substance use prevention parenting program, on diet and substance use outcomes among Latinx middle school students (6th-8th grade). The 3-arm cluster randomized controlled trial compares FPNG Plus (substance use prevention and healthy nutrition), FPNG (substance use prevention only), and a comparison condition (focusing on academic success) in 1494 parent-child dyads from 18 schools, randomized at the school level. Adolescents and parents will complete surveys pre- and post-intervention, and 16-weeks after program participation, regarding diet behaviors, substance use, and parenting practices. A random subsample of 126 dyads (42 from each program), will participate in additional data collection to assess the home food environment, detailed dietary intake (via two 24-h recalls), and provide biomarkers of cardiometabolic risk (blood pressure, total cholesterol and HbA1c). If successful, this study will provide evidence contributing to helping Latinx parents assist their adolescent children develop and maintain long-lasting positive lifestyle behaviors in order to prevent concurrent substance use and diet-related chronic diseases.
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Affiliation(s)
- Sonia Vega-López
- College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004, United States of America; Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America.
| | - Flavio F Marsiglia
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Stephanie Ayers
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Lela Rankin Williams
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Meg Bruening
- College of Health Solutions, Arizona State University, 550 North 3rd Street, Phoenix, AZ 85004, United States of America
| | - Anaid Gonzalvez
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Beatriz Vega-Luna
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Alex Perilla
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Mary Harthun
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America
| | - Gabriel Q Shaibi
- Southwest Interdisciplinary Research Center, School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, 201 North Central Avenue, 33rd Floor, Phoenix, AZ 85004, United States of America; College of Nursing and Health Innovation, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, United States of America
| | - Freddy Delgado
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Christian Rosario
- American Dream Academy, Arizona State University, 542 E. Monroe Street, Suite D-100, Phoenix, AZ 85004, United States of America
| | - Leopoldo Hartmann
- College of Nursing and Health Innovation, Arizona State University, 500 North 3rd Street, Phoenix, AZ 85004, United States of America
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Marsiglia FF, Ayers SL, Han S, Weide A. The Role of Culture of Origin on the Effectiveness of a Parents-Involved Intervention to Prevent Substance Use Among Latino Middle School Youth: Results of a Cluster Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 20:643-654. [PMID: 30536189 PMCID: PMC6542716 DOI: 10.1007/s11121-018-0968-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to assess the combined effectiveness of a parenting intervention, Families Preparing the New Generation (FPNG), and a youth curriculum, keepin' it REAL (kiR), on substance use prevention for middle school students in a large urban metro area of the southwest USA. The study aimed to generate usable knowledge on what works in adolescent substance use prevention and how it works best-a combined parent and youth programming or parent-only programming. A total of 532 adolescents in the 7th grade from 19 participating middle schools were randomly assigned into three intervention conditions: parent-youth (PY), parent-only (PO), and comparison (C). This article focuses on the comparison between PY and PO in order to determine which intervention strategy works best to reduce adolescent substance use including alcohol, inhalant, cigarette, and marijuana uses. A generalized estimating equation (GEE) model examined the longitudinal data. The results for alcohol use show that PO yielded better results than PY and that PY outperformed C after 20 months. Further, PO showed a decreasing trajectory in any substance use over time since the implementation of the intervention. The effect sizes based on Cohen's h indicate small effects in any substance use and alcohol use for PO condition and smaller effects for the PY condition. These findings have implications for the design of future culturally specific parenting and youth prevention interventions with Latino families.
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Affiliation(s)
- Flavio F Marsiglia
- Global Center for Applied Health Research (GCAHR), Arizona State University, Phoenix, AZ, USA
| | - Stephanie L Ayers
- Global Center for Applied Health Research (GCAHR), Arizona State University, Phoenix, AZ, USA
| | - SeungYong Han
- Global Center for Applied Health Research (GCAHR), Arizona State University, Phoenix, AZ, USA.
| | - Arianna Weide
- Global Center for Applied Health Research (GCAHR), Arizona State University, Phoenix, AZ, USA
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Marsiglia FF, Ayers SL, Kiehne E. Reducing inhalant use in Latino adolescents through synchronized parent-adolescent interventions. J Prev Interv Community 2019; 47:182-197. [PMID: 31021304 PMCID: PMC6980717 DOI: 10.1080/10852352.2019.1603675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article presents the effects of a synchronized Latino youth/parent intervention on adolescent inhalant use. The analytic sample included only Latino adolescents (n = 487) between the ages of 12 and 14. Randomized at the school-level, the design included three possible conditions: (1) child and parent received the prevention interventions, (2) only the parent received the prevention intervention, (3) neither child or parent received the prevention interventions. Drawing from the eco-developmental perspective, the overall hypothesis was that youth randomly assigned to the condition with both interventions will report the strongest inhalant use prevention outcomes. Descriptive statistics and regression tests of significant group differences by treatment condition confirmed the overall hypothesis. Children receiving the youth intervention and whose parents received the synchronized parenting intervention reported the strongest desired inhalant prevention effects. The findings are interpreted from an eco-developmental perspective and implications for practice, policy, and future research are discussed.
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Affiliation(s)
- Flavio F Marsiglia
- a Southwest Interdisciplinary Research Center, School of Social Work , Arizona State University , Phoenix , Arizona , USA
| | - Stephanie L Ayers
- a Southwest Interdisciplinary Research Center, School of Social Work , Arizona State University , Phoenix , Arizona , USA
| | - Elizabeth Kiehne
- a Southwest Interdisciplinary Research Center, School of Social Work , Arizona State University , Phoenix , Arizona , USA
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14
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Randomized effectiveness trial of a parent and youth combined intervention on the substance use norms of Latino middle school students. J Subst Abuse Treat 2019; 97:75-83. [DOI: 10.1016/j.jsat.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/06/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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15
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Roche KM, Little TD, Ghazarian SR, Lambert SF, Calzada EJ, Schulenberg JE. Parenting Processes and Adolescent Adjustment in Immigrant Latino Families: The Use of Residual Centering to Address the Multicollinearity Problem. JOURNAL OF LATINX PSYCHOLOGY 2019; 7:6-21. [PMID: 38463446 PMCID: PMC10923570 DOI: 10.1037/lat0000105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Family cohesion and parental monitoring promote Latino adolescents' positive adjustment. For Latino immigrant families, these parenting processes tend to be interdependent due to shared roots in cultural values emphasizing family togetherness and parental authority. This covariance poses a significant methodological problem with respect to multicollinearity. The present article uses a novel technique-residual centering-to remove shared variance among family cohesion and parental monitoring constructs and, in turn, to identify how the unique variance of each is associated with Latino adolescent adjustment. Participants include 249 9th and 10th graders in Mexican and Central American immigrant families. We compared findings from structural equation models in which parenting constructs were examined simultaneously with residual-centered models, in which shared variance among parenting constructs was removed for each parenting variable. Findings from residual-centered models revealed that parents' monitoring of youth's daily activities was associated with less alcohol use and fewer youth depressive symptoms, and that parents' monitoring of youth's peer activities outside the home was associated with less marijuana use and more depressive symptoms. Family cohesion was unrelated to Latino youth outcomes in residual-centered models. By isolating specific, "pure" parenting effects, residual centering can clarify the ways in which family cohesion and parental monitoring behaviors matter for Latino adolescents' adjustment.
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Affiliation(s)
- Kathleen M Roche
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University
| | - Todd D Little
- Department of Educational Leadership and Psychology, Texas Tech University
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16
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Use of Web-Based Parent-Adolescent Health Promotion Program Among Puerto Ricans. Nurs Res 2018; 67:473-484. [PMID: 30067581 DOI: 10.1097/nnr.0000000000000306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information. OBJECTIVE The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent-adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents. METHODS This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent-adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed. RESULTS Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%). DISCUSSION Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.
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Córdova D, Mendoza Lua F, Ovadje L, Hong E, Castillo B, Salas-Wright CP. Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review. JMIR Public Health Surveill 2017; 3:e96. [PMID: 29237577 PMCID: PMC5745352 DOI: 10.2196/publichealth.7129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth. OBJECTIVE The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth. METHODS We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included. RESULTS Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. CONCLUSIONS Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed.
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Affiliation(s)
- David Córdova
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Frania Mendoza Lua
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Lauretta Ovadje
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | - Ethan Hong
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, United States
| | - Berenice Castillo
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
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Parenting in 2 Worlds: Effects of a Culturally Adapted Intervention for Urban American Indians on Parenting Skills and Family Functioning. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 17:721-31. [PMID: 27129476 DOI: 10.1007/s11121-016-0657-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Parenting in 2 Worlds (P2W) is a culturally grounded parenting intervention that addresses the distinctive social and cultural worlds of urban American Indian (AI) families. P2W was culturally adapted through community-based participatory research in three urban AI communities with diverse tribal backgrounds. This paper reports the immediate outcomes of P2W in a randomized controlled trial, utilizing data from 575 parents of AI children (ages 10-17). Parents were assigned to P2W or to the comparison group, an informational family health curriculum, Healthy Families in 2 Worlds (HF2W). Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. Pretests were administered at the first workshop and a post-test at the last workshop. Tests of the efficacy of P2W versus HF2W on parenting skills and family functioning were analyzed with pairwise t tests, within intervention type, and by baseline adjusted path models using FIML estimation in Mplus. Intervention effect sizes were estimated with Cohen's d. Participants in P2W reported significant improvements in parental agency, parenting practices, supervision and family cohesion, and decreases in discipline problems and parent-child conflict. Compared to HF2W, P2W participants reported significantly larger increases in parental self-agency and positive parenting practices, and fewer child discipline problems. Most of these desired program effects for P2W approached medium size. Culturally adapted parenting interventions like P2W can effectively strengthen parenting practices and family functioning among urban AI families and help address their widespread need for targeted, culturally grounded programs.
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Little TD, Widaman KF, Levy R, Rodgers JL, Hancock GR. Error, Error in My Model, Who’s the Fairest Error of Them All? RESEARCH IN HUMAN DEVELOPMENT 2017. [DOI: 10.1080/15427609.2017.1370965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Williams LR, Ayón C, Marsiglia FF, Kiehne E, Ayers S. Acculturation Profiles and Associations With Parenting Among Immigrant Latinos. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2017. [DOI: 10.1177/0739986317725509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acculturation and accompanying acculturative stress affects the parenting practices of Latino immigrants. We (a) examine acculturation profiles based on heritage culture orientation, mainstream culture orientation, familismo, and acculturative stress; (b) describe how social support informs Latinos’ acculturation profiles; and (c) test how these acculturation profiles are associated with parenting behaviors (including parental involvement, monitoring, agency, and discipline self-efficacy) and family conflict. A three-step latent profile analysis revealed five profiles of acculturation: Cultural Individualism ( n = 168, 15%), Cultural Engagement ( n = 810, 71.3%), Cultural Assimilation ( n = 47, 4.3%), Cultural Disengagement ( n = 23, 2.1%), and Cultural Stress ( n = 77, 7.3%). Social support predicted the Cultural Engagement profile, which was associated with positive parenting behaviors and family functioning. The Cultural Stress profile was associated with detrimental parenting behaviors and family conflict. Recommendations include family interventions that effectively support and strengthen culturally competent coping strategies in response to acculturative stress as a means to promote positive parenting practices.
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Jenkins EK, Slemon A, Haines-Saah RJ. Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people's harm minimization strategies. Harm Reduct J 2017; 14:53. [PMID: 28760146 PMCID: PMC5537985 DOI: 10.1186/s12954-017-0180-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 07/25/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people's social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development. METHODS This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site. RESULTS Across all three sites, young people's individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts. CONCLUSIONS The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the development of harm reduction programming are needed to ensure that approaches are relatable and meaningful to young people, and effective for promoting the minimization of substance-related harms.
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Affiliation(s)
- Emily K. Jenkins
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - Allie Slemon
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5 Canada
| | - Rebecca J. Haines-Saah
- Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4 Canada
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